Bringing liver health into the obesity conversation at ICO2026

From 14–17 July, the Global Think-tank on Steatotic Liver Disease brought liver health into discussions at the International Congress on Obesity (ICO2026) in Mexico City through a series of scientific, clinical and policy-focused engagements exploring the connections between steatotic liver disease, obesity, diabetes and wider metabolic health.

Drawing on its multidisciplinary community of practice, the Think-tank helped connect expertise across hepatology, endocrinology, obesity, diabetes and public health. This brought together perspectives that are too often addressed separately despite the close links between these conditions.

This work is supported by the ISGlobal Public Health Liver Group (PHLG), which drives the Think-tank’s policy arm and leads research aimed at strengthening the evidence needed to inform policy and health-system change.

Across the week, Think-tank Director Professor Jeffrey V. Lazarus, Dr Priya Jaisinghani, Dr Mary “Maru” Rinella, Professor Silvana Pannain and International Diabetes Federation President Professor Peter E. H. Schwarz contributed to sessions alongside other international and Mexican experts.

The programme began at the World Obesity Federation SCOPE School Mexico, where Professor Lazarus delivered a lecture in Spanish on integrating MASLD/MASH assessment and action into obesity care.

On 16 July, the satellite symposium Futuring Liver Disease, Obesity, and Diabetes Care brought together Professor Lazarus, Dr Jaisinghani and Dr Rinella to discuss with Chris Kopka (a lawyer by training) how advances in treatment must be matched by health-system readiness, equitable access, appropriate resource allocation and more integrated care pathways.

A second symposium, Obesity Associated Diseases: Let’s Not Forget Them, broadened the discussion further. Moderated by Professor Lazarus, the session included Professor Silvana Pannain, Dr Juan Mauricio Vera Zertuche, Dr Yadira Guadalupe Rodriguez Reyes and Laurent Turner. Together, they examined MASLD/MASH and other obesity-associated conditions that risk being overlooked when care remains organised in disease silos.

The programme concluded on 17 July with a Meet the Experts session featuring Professor Lazarus, Professor Schwarz and Dr Rinella, moderated by Dr Jaisinghani. The discussion explored steatotic liver disease nomenclature, multimorbidity, NCDs and the implications of the World Health Assembly resolution on steatotic liver disease.

Together, these conversations reflected a central challenge now facing the field: scientific and clinical progress must translate into systems that identify people earlier, connect care across conditions and improve access equitably. The high and growing burden of steatotic liver disease demands urgency with purpose, with action that is coordinated, evidence-based and accountable.

Connecting The Conversation to Evidence from Mexico

ICO2026 also created a timely opportunity to ground these discussions in country-specific evidence.

Research led by the CUNY Graduate School of Public Health and Health Policy and the ISGlobal Public Health Liver Group, together with Mexican and international collaborators, examined the public health threat of SLD in Mexico and was released to coincide with ICO.

The findings reinforced a clear message: liver health should be integrated into existing obesity, diabetes and NCD programmes rather than addressed in isolation.

The research highlighted the substantial burden of MASLD, gaps in screening and surveillance, and opportunities to strengthen prevention, earlier diagnosis and care through more integrated approaches.

This is also where ingenuity matters. Progress does not always require creating parallel systems. It can mean making existing health programmes work more effectively together, identifying opportunities for earlier intervention and ensuring liver health is included wherever people at greatest risk are already receiving care.

Communications around the research launch helped extend these findings into wider public and policy discussion, generating at least 13 media and online stories across national, regional and international outlets, including Milenio and La Jornada.

The Global Think-tank amplified these messages through its policy platform, expert network and communications channels. Social media activity around ICO2026 generated >3,000 impressions and 276 clicks, helping the conversation reach audiences working across liver health, obesity, diabetes and metabolic health beyond those attending the congress.

ICO2026 demonstrated how the Think-tank’s model can work in practice: convening multidisciplinary expertise, connecting science with policy and health-system questions, and amplifying evidence so that it can reach the people and institutions positioned to act.

Underpinning this work is a commitment to equity, collaboration and science that remains centred on people rather than diseases in isolation.

With 2030 approaching, the opportunity is not simply to increase awareness of steatotic liver disease. It is to include all aspects of liver health in universal health coverage programmes so that global commitments translate into measurable change for the people most affected.

U53R_4N7H0NY2026-07-25T20:20:09+00:00

Registration fees

All applications for registration will be reviewed, and you will be notified of your invitation status and fee via email within one week.

Category	Early Bird (before 1 April)	After / onsite
Private Sector/Industry	295	350
Start-up*	95	150
Healthcare Professional, Academic, Public Health/Professional Association, NGO	75	100
Young Researcher / Trainee / PostDoc / Student / Young Person (under 25) *	45	60
Patient with lived experience *	free	free
Patient or Patient Representative *	45	50

* Registration fee scholarship offered on application, please email: lisa.rice@isglobal.org

Criteria for start-ups:

Early-stage startup (e.g., pre-seed, seed, or Series A).
Incorporated for under 5 years
Raised under $5 million in funding
Annual revenue less than $1 million
Fewer than 50 employees

What’s included in your ticket?

Entry to lunch main agenda sessions 1pm-7pm on 26 May and evening reception

5. Strengthen the capacity of community health services to prevent and treat MASLD through social prescribing

Primary care has a well-established network of health centres across Spain. In the last years, there has been an increase in the number of community-based activities promoting well-being and reducing the metabolic risk profile through social prescribing. These activities usually integrate exercise through increasing physical activity.⁴⁵ Strengthened primary care systems can reinforce the role of community health services by incorporating social prescribing models to address lifestyle drivers of MASLD in vulnerable populations, such as physical activity, which is a recommended first-line therapy of people with MASLD, and can improve psychosocial health,⁴⁶ which is often reported as poor by people living with MASLD.⁴⁶ By facilitating participation in community-based activities like group exercise, arts, or wellness programs, social prescribing addresses both physical inactivity and the isolation or low mood commonly seen in this population.⁴⁷ In Catalonia, the Programa de Prescripció Social i Salut exemplifies this approach by linking patients to local community assets via an integrated system in primary care, particularly targeting conditions such as anxiety, depression, and social isolation,⁴⁴ and which may be beneficial for people living with MASLD/MASH. Elsewhere, social prescribing has demonstrated benefit for people living with diabetes.⁴⁸ Evaluation data from Catalonia show that over 70% of participants report improvements in emotional well-being and social support after engaging in prescribed community activities frequently related to physical activity.⁴⁴

5. Leverage electronic health records (EHR) through integrated automated diagnostic tools

Integrating MASLD/MASH screening algorithms into existing EHR systems can substantially enhance early detection and risk stratification in primary and secondary care. Automated tools such as intelligent liver function testing (iLFT)—which systematically interprets routine liver function tests, performs reflex testing, and identifies likely liver diseases for physicians to consider—have shown promise in improving early diagnosis and care pathways, particularly in underdiagnosed conditions like MASLD and MASH.⁴³ In the Spanish context, where nearly 10 million individuals may be living with MASLD by 2030,³ embedding such tools in the primary care EHR systems used across autonomous communities could standardise assessment, reduce diagnostic delays, and promote timely secondary referrals. Moreover, this approach complements digital transformation priorities already outlined in Spain’s National Health System and aligns with the objectives of the Strategic Framework for Primary and Community Care (2019).^26,44

4. Increase awareness and education of MASLD/MASH among at-risk groups and healthcare professionals

Enhancing awareness of MASLD/MASH among both at-risk populations—such as those living with obesity, diabetes, and metabolic syndrome—and frontline healthcare workers is critical for early identification, appropriate risk stratification and timely intervention. Given its silent clinical course, MASLD is often underdiagnosed until advanced stages, particularly in primary care settings where patients with obesity, diabetes, or metabolic syndrome are commonly managed.

Spain’s Strategic Framework for Primary and Community Care (2019) already emphasises chronic disease prevention, making it an ideal entry point for MASLD/MASH education.²⁶ Yet, existing knowledge gaps among primary care providers regarding liver disease etiology, progression, and appropriate screening necessitate awareness or education campaigns and professional training modules that build the knowledge and clinical skills needed to manage MASLD in frontline settings.^24,41 A cohesive and comprehensive educational strategy is essential and could begin with the integration of MASLD/MASH-specific content into undergraduate, specialty, and continuing medical education curricula to foster competency in metabolic hepatology across the care continuum. A national interdisciplinary training strategy could bring together professionals from family medicine, endocrinology, cardiology, nephrology, internal medicine, endoscopy, clinical nutrition, and hepatology to address MASLD/MASH as a complex, multisystemic disorder.

A comprehensive communication and engagement health literacy strategy should position MASLD/MASH as serious, progressive, and multisystemic conditions. This involves dismantling the minimising narrative of “fatty liver” and clearly linking MASLD to major outcomes such as cardiovascular, renal and metabolic disease. Such a campaign should incorporate the concept of MetALD, which captures the under-recognised harm of moderate alcohol use in people with MASLD. Establishing a national MASLD/MASH patient platform would also enable the co-design of care pathways, educational materials, public campaigns, and research priorities, ensuring patient-centered policy and practice.

Finally, it is critical to explicitly position MASLD within the cardio-renal-metabolic axis, evolving toward a CHRM model (cardiovascular-hepatic-renal-metabolic).⁴² This paradigm recognises the liver as a pivotal organ in systemic metabolic dysfunction. The CHRM paradigm reflects the shared pathophysiology and clinical trajectories of MASLD, T2DM, chronic kidney disease, and cardiovascular disease. Scientific societies and patient organisations in Spain must collectively support and disseminate this integrative model, aligning MASLD policy with broader strategies for non-communicable diseases.

3. Add MASLD/MASH as an indicator to the list of Key Health System Indicators

Despite the rising clinical, social, and economic burden of MASLD, this condition is not currently included among Spain’s Key Health System Indicators, which guide monitoring, evaluation, and resource distribution across the National Health System.14 Integrating MASLD/MASH as a formal indicator would recognise the disease as a strategic health priority by integrating it into the national health information system, guiding decision-making on screening, diagnosis, and care pathways. Failure to track this disease risks underestimating its long-term economic and public health impacts. Incorporation into the indicator framework aligns with Spain’s commitment to data-driven governance and would support benchmarking across autonomous communities. To support targeted local action on MASLD, tools at the autonomous community level should be developed to guide policy and programme implementation. A MASLD risk index, combining aggregated clinical data, social determinants of health, and population-level metrics, can help identify high-need areas and inform municipal-level screening strategies. In parallel, a MASLD Impact Score should be created to assess the effectiveness of local policies related to metabolic health, food regulation, healthy environments, early detection practices, and workforce training. This metric could be implemented through municipal initiatives such as the upcoming “Santander se mueve” health promotion program, set to launch in September 2025.

2. Create a national MASLD registry, cohort, or observatory

Establishing a national MASLD registry, cohort or observatory is a critical step toward advancing clinical management, research, and policy evaluation. A national registry would enable the systematic collection of epidemiological, clinical, and sociodemographic data, essential for monitoring disease prevalence and progression, identifying high-risk subgroups, and assessing territorial disparities in access to care. While the Epidemiological sTudy of Hepatic infectiONs (ETHON) cohort estimated that 1.33%% of the Spanish population from 2015-2020 had MASH with fibrosis (stage F2-F3), these findings are limited to participants from primary care centers in Madrid, Santander and Valencia.^12,39 Additionally, while national clinical registries like HEPAmet and REGHNA (focused on hospital settings) provide important data, they are not population-based, nor are they consistently linked with public health surveillance systems.⁴⁰ A standardised and centralised MASLD registry would enable longitudinal tracking of this more prevalent disease, facilitate research on progression and treatment outcomes, and help evaluate the impact of interventions over time. Furthermore, registry data could support regional health planning and inform clinical practice guidelines aligned with Spain’s digital health transformation efforts.

1. Launch a Ministry of Health-led whole-of-government strategy

The growing prevalence of MASLD and MASH in Spain—projected to affect over 27% and 5.9% of the population, respectively, by 2030—necessitates an integrated, cross-sectoral policy response,³ led by an intersectoral working group under the leadership of the Ministry of Health. This whole-of-government initiative could facilitate the mainstreaming of MASLD/MASH into key national strategies addressing chronic diseases in general, and obesity, diabetes, and cardiovascular health specifically through a “health in all policies” approach. These strategies include the Strategy for Addressing Chronic Diseases (2012),²⁷ the Diabetes Strategy (2006)²⁸ and its 2012 update²⁹, and the Cardiovascular Health Strategy (2022),³⁰ where MASLD/MASH remain largely underrepresented despite their metabolic underpinnings. This omission contributes to fragmented care and missed opportunities for early intervention. Systematic integration of MASLD across these strategies would allow Spain to align with recommendations from the EASL–Lancet Liver Commission, which urges countries to address liver diseases through upstream, equity-based, and multisectoral policies.³²

Crucially, national leadership must be paired with urban action. Cities are where obesogenic environments, food insecurity, and social inequalities converge with high diabetes and obesity prevalence. An initiative to address this, “MASH Cities,” calls on municipalities to integrate MASLD/MASH into local health promotion, food policy, urban mobility, and primary care services to mitigate disease progression.³³ Major cities in Spain should consider joining this growing platform for sharing learned lessons and best practices. Empowering cities with the mandate and resources to act on liver health can serve as a scalable, equitable response to this growing challenge, as was proposed for Barcelona in May 2025.³⁴

Additionally, inclusion of MASLD/MASH in Spain’s Public Health Surveillance Strategy (2022)³⁵ could strengthen early detection and monitoring by enabling systematic data collection and risk assessment in both health and non-health sectors, such as urban planning and food policy. Primary care would be central to this approach, serving as the frontline for MASLD screening, risk stratification, and referral. Integration can help standardise primary care practices, including routine FIB-4 risk stratification of individuals with obesity, T2D, metabolic syndrome, or hepatic steatosis—which are often undetected until advanced stages.³⁶ Primary care should be adequately funded and equipped to screen, stratify, manage cardiometabolic risks, and refer high-risk patients, forming the backbone of MASLD/MASH prevention and control at the national, autonomous community, and city levels.^37,38